Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Eric L. Garland, Adam W. Hanley, Michael R. Riquino, Sarah E. Reese, Anne K. Baker, Karen Salas, Brooke P. Yack, Carter E. Bedford, Myranda A. Bryan, Rachel Atchley, Yoshio Nakamura, Brett Froeliger, Matthew O. Howard

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p <.001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p =.048), which in turn predicted decreases in opioid misuse risk by follow-up (p =.02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.

Original languageEnglish
Pages (from-to)927-940
Number of pages14
JournalJournal of Consulting and Clinical Psychology
Volume87
Issue number10
DOIs
StatePublished - Oct 2019

Keywords

  • Mindfulness
  • Nondual awareness
  • Opioid
  • Pain
  • Positive emotion

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